long term results of  HR are astonishing with >90% survivorship at 15y FU (Mc Minn, Tracy, Hamstutz...). look at Autralian registry (AOA) who shows same results. best indication is man

Dear Panayot:

Dear Panayot

I have no experience with resurfacing because I am very satisfied with the results of THR. In the paper:  Socket position determines hip resurfacing 10-year survivorship , Amstutz HC1, Le Duff MJ, Johnson AJ.  ,Clin Orthop Relat Res. 2012 Nov; 470(11):3127-33  the conclusions are:  Acetabular component orientation, a factor within the surgeon's control, determines the long-term success of our current hip resurfacing techniques. Current techniques have changed the modes of failure from aseptic femoral failure to wear or loosening of the acetabular component.

Thank you, Nelson, 

I agree with your opinion. I do not apply hip resurfacing either, because I am very satisfied with the conventional THR. 

Regards

I agree with you but HR remains a good option for young high demand patient with at risk dislocation activities (roof workers, some sports...): no occupational reclassification anymore !

Dear Dr. Riviere,

Obviously, HR could be an option for younger patients, keeping in mind that more bone stock is preserved for an eventual revision later, and the revision would be easier to perform. 

Regards

HR is the most suitable option for young and active patients

My personal series about patients under 30 years old with HR is 100% at 6 years FU

and overall 99,2% at 8,5 years (mean age (52 years)

As far as hip resurfacing is concerned, it is a high demand surgery meant only for high demand individuals. It fell into disrepute because of design issues of ASR from DePuy and few others (Durom from Zimmer) leading to very high failure rates. However, BHR from Smith & Nephew has had excellent results at both the designing centers as well as other centers. A recent results' analysis is available at http://www.ncbi.nlm.nih.gov/pubmed/25708400

 Personally, I reserve this implant for high demand individuals but not to be used in avascular necrosis. Revising a well integrated resurfacing cup can be a pain. Fortunately, we don't have to revise many. In case you have to revise any, my published technique (copy attached) for revising the same is available at  http://journals.lww.com/techortho/Abstract/publishahead/Revision_of_a_Well_fixed_Brimingham_Hip.99971.aspx

http://journals.lww.com/techortho/Abstract/publishahead/Revision_of_a_Well_fixed_Brimingham_Hip.99971.aspx

Article Revision of a Well-fixed Brimingham Hip Resurfacing Cup—Modi...

it remains  an option in young individuals

Hip Resurfacing (HR) development of the 1970s was an attempt to address the failures of conventional cemented stems. Those early HR designs failed because problems with maintaining bone under the resurfaced femoral head, and loosening of the socket with substantial acetabular bone loss. However technology, knowledge and surgical techniques have evolved over the past 45 years. The more recent designs like the Birmingham Hip Resurfacing (BHR) focused on metal to metal bearing surfaces. These devices are under attack and maybe they should be. However, lets not ignore the significant amount of information and potential improvements in both design technology and surgical techniques that have come about over the past few years.

The Medical Healthcare Products Regulatory Agency (MHRA June, 2015) warned of higher risks with 46-48mm sizes of BHR hip resurfacing arthroplasty (HRA). For the

46mm and 48mm cups highlighted in the MHRA alert, the critical cup inclinations where edge-wear became a risk occurred at 65-66º, revealing an insignificant difference with respect to diameters. This warning brings with it a level of confusion and implies that the critical factor is small sizes (46-48) when in fact the real risk is not the size of the implant but the inclination (position) of the implant.

“For the 46mm and 48mm cups highlighted in the MHRA alert, the critical cup inclinations where edge-wear became a risk occurred at 65-66°, revealing

an insignificant difference with respect to diameters. The MOS-algorithm also indicated that lower lateral-inclination angles were particularly beneficial, i.e. a 46mm cup positioned at 50° inclination would exhibit a higher margin of safety than either 48mm or 50mm sizes positioned at 55° inclination. This evidence supported clinical studies that recommended BHR cup inclinations of 50-55° or lower as optimal for reducing metal-ion concentrations.”

Hip Reurfacing remains a viable option but should only be preformed by Leaders that have significant experience in this high demand surgical field.

Safety Issue of Hip Resurfacing,

A Commentary

McTighe T 1, Acknowledgments to: Clarke I, Lazennec J

In light of Panayot question on HR, I would like to hear recommendations as to current device selection with regard to HR and/or conventional THA.

Example: Cemented stem and cementless cup with 32 mm C.C. or ceramic head in type C bone or age over 80 years.

Cementless stem either conventional or short neck preserving in type A & B bone with ceramic 32 or 36 mm head on enhanced poly.

I see little value in ceramic on ceramic bearings over ceramic on today's poly and no value in MoM bearings in THA.

Thanks

Tim